Patient’s $7,800 ED bill reaches California Supreme Court

https://www.beckershospitalreview.com/finance/patient-s-7-800-ed-bill-reaches-california-supreme-court.html

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A case involving a hospital patient’s emergency department bill has been initiated at the California Supreme Court, a spokesperson for the Judicial Council of California confirmed to Becker’s.

He said the supreme court received a petition for review from the patient, and it has at least 60 days to decide whether it will grant, deny or take other action.

The petition centers on an unpublished opinion by the Fifth District Court of Appeal issued in July that would allow self-pay patients treated at Community Regional Medical Center in Fresno, Calif., and Clovis (Calif.) Community Medical Center to challenge their medical expenses as part of a class action, The Fresno Bee reported.

The appeals court decision reversed a trial court order denying class certification; directed certification of an “issue class”; and denied the the patient’s request to publish the opinion. But now the patient has petitioned the supreme court to get the opinion published. “Unpublished or ‘noncitable’ opinions are opinions that are not certified for publication in official reports and generally may not be cited or relied on by other courts or parties in other actions,” the spokesperson for the Judicial Council of California said. However, if the case were published, it would become case law, potentially affecting lawsuits against hospitals statewide.

Hospital officials have argued the case should not be published.

The case goes back to a dispute over interpretation of Community Regional Medical Center’s admissions contract and the rates charged to an uninsured emergency room patient, Cesar Solorio, according to the appeals court decision. Mr. Solorio reportedly received X-rays and a splint on his wrist at the hospital on Sept. 22, 2015. He later received a bill for $7,812.03 and filed a class-action complaint alleging rates billed to self-pay patients are “inflated and exorbitant,” the appeals court decision states.

Community Medical Centers, the operator of Community Regional Medical Center and Clovis Community Medical Center, disputes claims that the self-pay billing process is different from insured patients, according to The Fresno Bee.

Michelle Von Tersch, vice president of communications and public affairs, told the publication documents regarding a patient’s treatment are reviewed to determine applicable charges after discharge. She said that many uninsured patients are eligible for financial aid programs, such as charity care.

Read the full Fresno Bee report here.

 

Senior finance executives name their top 10 RCM initiatives

http://www.beckershospitalreview.com/finance/senior-finance-executives-name-their-top-10-rcm-initiatives.html

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To optimize revenue cycle workflows, senior healthcare finance executives are more likely to implement updated IT and hire additional staff than contract with outside consulting services, according to a recent survey by Connance.

Connance, in conjunction with Porter Research, surveyed 93 senior finance executives in an 11-question online survey regarding their organizations’ revenue cycle improvement priorities. Respondents completed the questionnaire in July.

Below are six survey findings.

This Nurse Leader Cut LOS by 40% in the Emergency Department

http://www.healthleadersmedia.com/nurse-leaders/nurse-leader-cut-los-40-emergency-department-0?spMailingID=9348186&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=980998666&spReportId=OTgwOTk4NjY2S0#

Around 2012, Ajimol Lukose, DNP, RN-BC, nursing director at Swedish Covenant Hospital in Chicago, noticed a trend—more patients with behavioral health issues were seeking treatment in the emergency department. This development came on the heels of the state cutting $113.7 million in general funds from its mental health budget, and Chicago closing of six of its 12 city-run mental health clinics.

“There was a reduction in mental health clinics, so the follow-up or outpatient programs were limited. That resulted in patients showing up in the emergency department,” Lukose told me.

On any given day, there could be as many as six or seven behavioral health patients in the ED.

“Our emergency department was struggling with patients with mental health issues staying there for three and four days and waiting for state transfer, especially unfunded patients,” she said.

At the same time, Lukose needed to implement a project for the doctorate of nursing practice degree she was working toward. She has a background in psychiatric nursing and thought she could help address some of the issues around caring for this patient population by developing a safe care delivery model to improve care quality and reduce length of stay in the ED.

Her results were even better than expected.

Tenet near settlement on Georgia kickback charges, posts 2015 Q4 loss

http://www.healthcaredive.com/news/tenet-near-settlement-on-georgia-kickback-charges-posts-2015-q4-loss/414403/